A psychoactive drug or psychotropic substance is a chemical substance that acts primarily upon the central nervous system where it alters brain function, resulting in temporary changes in perception, mood, consciousness and behavior. These drugs may be used recreationally to purposefully alter one's consciousness, as entheogens for ritual or spiritual purposes, or therapeutically as medication.

Psychiatric medications

There are 6 major classes of psychiatric medications:

Antidepressants, which are used to treat disparate disorders such as clinical depression, dysthymia, anxiety, and eating disorders and affect dysregulation, colloquially termed 'mood stabilization' in borderline personality disorder.

Stimulants, which are used to treat disorders such as attention deficit disorder and narcolepsy and to suppress the appetite.

Antipsychotics, which are used to treat psychoses such as schizophrenia and mania.

Mood stabilizers, which are used to treat bipolar disorder and schizoaffective disorder.

Anxiolytics, which are used to treat anxiety disorders.

Depressants, which are used as hypnotics, sedatives, and anesthetics.

1. Antidepressants

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are a family of antidepressants considered to be the current standard of drug treatment. This family of drugs includes fluoxetine (Prozac), paroxetine (Paxil), escitalopram (Lexapro, Esipram), citalopram (Celexa), and sertraline (Zoloft).

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor) and duloxetine (Cymbalta) are a newer form of antidepressant that works on both norepinephrine and 5-HT. They typically have similar side effects to the SSRIs, although there may be a withdrawal syndrome on discontinuation that may necessitate dosage tapering.

Noradrenergic and specific serotonergic antidepressants (NASSAs)

antidepressants continued next page

Noradrenergic and specific serotonergic antidepressants (NASSAs) form a newer class of antidepressants which purportedly work to increase norepinephrine (noradrenaline) and serotonin neurotransmission by blocking presynaptic alpha-2 adrenergic receptors while at the same time minimizing serotonin related side-effects by blocking certain serotonin receptors. The only example of this class in clinical use is mirtazapine (Avanza, Zispin, Remeron).

Norepinephrine (noradrenaline) reuptake inhibitors (NRIs)

Norepinephrine (noradrenaline) reuptake inhibitors (NRIs) such as reboxetine (Edronax) act via norepinephrine (also known as noradrenaline). NRIs are thought to have a positive effect on concentration and motivation in particular, though they have been known to increase aggression.

Norepinephrine-dopamine reuptake inhibitors

Tricyclic antidepressants (TCAs)

Tricyclic antidepressants are the oldest and include such medications as amitriptyline and desipramine. Tricyclics block the reuptake of certain neurotransmitters such as norepinephrine (noradrenaline) and serotonin.

Monoamine oxidase inhibitor (MAOIs)

Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil)

2. Stimulants / Amphetamines

Many children and teens with ADHD take a medication called methylphenidate, better known by the brand name Ritalin. But although methylphenidate drugs are the medications that are most frequently prescribed to manage ADHD, lots of children take other medicines to control their ADHD symptoms.

In addition to methylphenidate drugs, doctors often prescribe other types of medication to help people with ADHD. Like Ritalin, amphetamines (such as Adderall) and dexamphetamines (such as Dextrostat or Dexedrine) treat ADHD by stimulating the brain's attention centers.

Non-Stimulants for ADHD and other Disruptive Behavior Disorders

Other types of medications that are prescribed for ADHD are nonstimulating and work differently. These include atomoxetine (like Strattera) and certain antidepressants (such as Wellbutrin). Alpha-2 Agonists are also used: Clonidine or Tenex.

Risperidone – Atypical antipsychotic used in the management of schizophrenia. It has also found use in the treatment of Tourette’s syndrome, bipolar disorder, autism, and aggressive behavior (12).

Risperidone (Risperdal) - Dosing 0.25 to 6 mg per day and is titrated upward; divided dosing is recommended until initial titration is completed at which time the drug can be administered once daily.

Quetiapine (Seroquel) - Used primarily to treat bipolar disorder and schizophrenia, and "off label" to treat chronic insomnia and restless legs syndrome; it is a powerful sedative (if it's used to treat sleep disorders and is not effective at 200 mg, it is not going to be effective in this regard).

Paliperidone (Invega) - Derivative of risperidone. Approved in December 2006.

4. Mood Stabilizers

A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by rapid and unstable mood shifts. The most common is bipolar disorder, where mood stabilizers suppress swings between mania and depression, and these drugs are also used in borderline personality disorder. Most mood stabilizers are anticonvulsants, with the important exception of lithium, which is the oldest and best known mood stabilizing drug.

Mood stabilizers include:

LithiumLithium carbonate —- Lithium is the 'classic' mood stabilizer. The first Food and Drug Administration-approved mood stabilizer, and still popular in treatment. Therapeutic drug monitoring required. Monitor blood lithium levels (therapeutic range: 0.6 or 0.8-1.2 mEq/L) and look for signs and symptoms of toxicity (such as nausea, vomiting, diarrhea, ataxia). See also lithium orotate, another lithium salt.

DepakoteValproic acid (Depakene®), divalproex sodium (Depakote®), and sodium valproate (Depacon®) — Available in extended release form. Can be very irritating to the stomach, especially when taken as valproic acid. Liver function and CBC should be monitored. Therapeutic drug monitoring is required.

LamictalLamotrigine (Lamictal®) — Particularly effective for bipolar depression. Monitor for signs and symptoms of Stevens-Johnson syndrome, very rare but can be fatal.

TegretolCarbamazepine (Tegretol®) — CBC should be monitored; can lower white blood cell count. Therapeutic drug monitoring is required. Not FDA-approved for bipolar disorder, but widely used for many years.

NeurontinGabapentin (Neurontin®) — Not FDA approved for bipolar disorder. Recent scientific studies suggest it is not an effective treatment, however many psychiatrists continue to use it.

Sometimes mood stabilizers are used in combination, such as lithium with one of the anticonvulsants.

5. Anxiolytics

Benzodiazepines

Benzodiazepines are prescribed for short-term relief of severe and disabling anxiety. Common medications are lorazepam (Ativan), clonazepam (Klonopin), alprazolam (Xanax), and diazepam (Valium). Benzodiazepines may also be indicated to cover the latent periods associated with the medications prescribed to treat an underlying anxiety disorder. These medications run the risk of dependence and rebound anxiety as well.

Non-benzodiazepines

Buspirone (Buspar) is a serotonin 1A agonist. It lacks the sedation and the dependence associated with benzodiazepines and causes much less cognitive impairment. It may be less effective than benzodiazepines in patients who have been previously treated with benzodiazepines as the medication does not provide the sedation that these patients may expect or equate with anxiety relief.

Alpha-2 Agonists are also used: catapres(Clonidine) or guanfacine (Tenex) reduce the anxiogenic effects of circulating Norepeneprhine NE. Beta blockers protect against social anxiety. Beta blockers, like Propranolol/Inderal, block the receptors for the physical effects of a person's natural fight or flight response. They are not sedatives, and they can't help anxiety of a purely psychological nature. These are blood pressure medication, also given for stage fright, and PTSD related anxiety and sleep disturbance.6. DepressantsHypnotics, sedatives, anesthetics.

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About Jane Rekas, LCSW, CHt

I am a Licensed Clinical Social Worker and now work at Western Psychological and Counseling Services in Gladstone and at Seth Lewelling Elementary. I am a Transpersonal and CBT Therapist, and also a Certified Hypnotist and Certified Past Life Regression Facilitator. I am also an astrologer and Reiki Master. I'm a graduate of Reed College (BA Psychology '87) and Portland State University (MSW '90), LCSW sine '97. I work with children, teens, adults, parents, groups.